Diagnostic needling has been first described by Dr. Mike Cummings, Medical Director of BMAS (British Medical Acupuncture Society), where a needle is used as a diagnostic tool. While puncturing the affected area a more precise determination of the exact tissue origin of the pain or symptom may be located. Thus an assessment can be made of the affected muscle or other soft tissue. After physical examination using standard techniques with active and passive movements, and palpation with hands and fingertips, the needle can be inserted into and through each tissue layer. The needle exerts a high pressure on each layer individually, whereas the fingertip compresses multiple layers at the same time. The patient is asked about reproduction of any recognised pain or symptom in each layer, and if the practitioner knows the anatomical layers they can locate the areas of relevant peripheral sensitivity more accurately than with the finger tip alone.
It can be used in all parts of the soma, but some areas are more likely than others, because physical examination is more difficult. For example where there are multiple muscle layers in a solid patient it is impossible to put much digital pressure on deep muscle, but a needle can easily apply the same pressure on the muscle in almost any patient. So the back and gluteal region is probably the most common.
This is most useful for soft tissue pain, especially muscle pain, but occasionally it can be useful in other cases. Entrapped nerves (rare but possible), facet joints (needling applied to joint margins perhaps), entheses.
TechniqueThe skin is penetrated in the affected area. With the tip of the needle we search or scan the region with the aim to provoke the (referred) pain experienced by the patient. (as above desrcibed)
NeedlesAcupuncture needles:
Length range: 15-100mm
Diameter range: 0,16-0,35mm
In general counts:
• A 30mm long and 0.18mm to 0.22mm gauge diameter is used in the face, neck, hands, and feet, as those areas are more sensitive.
• A 50mm to 100mm and 0.30/0.35mm gauge needle is used for the gluteal region in most patients.
• A 30mm and 0.25mm to 0.30mm gauge needle is generally used everywhere else.
This test is prescribed to control a migraine attack, but probably is useful in other conditions.
TheoryThe needle contact test (NCT) is a diagnostic technique useful to identify, through the contact of the needle on the skin of the ear, the most efficacious points for reducing pain during a pain migraine attack.
TechniqueWith a specific algometer the most tender points have to be traced via the pain pressure test in the ipsilateral ear of the migraine attack. The identified tender points are subsequently tested by the NCT: an acupuncture needle is placed with its tip in contact with the skin without penetration for 10 sec. When reached at least 25% reduction in pain in respect to the initial pain, a treatment can be initiated.
Needles0,33 mm diameter acupuncture needle.